15734 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15fi3.4
INSPECTION DIVISION
1 I1 �,.,,,y�JOB INSPECTION RECORD
JOB ADDRESS `OI�I w�l Minl PERMIT EXPIRATION'
- UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER •r� 1 V� CONTRACTOR 14IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .AN onus of PERMIT
FOUNDATION NOTE: AST- LAST CALLED
180 DAYS FROM
ALLED INSPECTION.
UFER- ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.'
GARAGE SLABS 111Ja 4'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG • eLECr I PLG. Meal
❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu DING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING '
MECHANICAL - - '
PEN IT TO
' ELECTRICAL '
FRAMING
INSULATION
STORIES TYPE CONSTH,
' �- - -
' OCC GROUP 'RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTALACREAGE
ROOF. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING use
ROOF SHEATHING - RES IND CON PB, Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ED
ASSLS50HS PARCEL NO
ROUGH SAN.#
PLUMBING - - ELECT.ENERGY °
TORS 8 SHOWER PAN _ � � PLUMBING ENERGY i14ACT NO PARCELNO
MECHANICAL - MECH. ENERGY- -
ELECTRICAL . . BUILDING ENERGY ACC DATE ACC Fi LE NO
FRAMING - - ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION - PLUMBING
GAS TEST _ GAS
FIHE SPRINK ENERGY.TBE
MECHANICAL �S• v 0 N� v - No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
'A,LUC
' EXTERIOR SHEARFLOODZONE it- ELECTRICAL RELEASE -
INTERIOR SHEAR'' FIRE DEPT.
Yo No ❑ NO
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT` - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING'M-4505, " ELECTRIC
_
I
LEI
.ONE'WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z°� PLEASE GIVE JOB ADDBESSWHEN PHONING:
= SEE PERMIT FOR EXPIRATION DATE — MECHANICAL _
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
-•BUI LOI NO PROJECT I DENTI FICATION APPLICATION & PERMIT
BUILDING
SS 15734
AU
\� 1 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
_
NAME OTY. ELECTRIC PERMIT FEE
CONTRACTOR
OR'S
NAmE OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES•RESIDENTIAL 4.00
_ AOOREss p
PHONE PANELS 10.00 DATE OF APPLICATION°
ARCHITECT C�\ VA�� PANELS (OVER 200 AMP1 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. ISIGNS TRANS. 3.00-
ADDDRESS eyG. SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
ZIP TEMPr METER OR POLE INS. 20.00 1 /LY14
APrucq"rs MOTORS SEE FEE SCH,ADDRESS _D,_ \l 5 IBJ IQ y• -
\ c'Y�C.r ESV \ 'l(Q SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
W v I hereby affirm that I a m licensed under provisions o1'Chapter 9 ISSUANCE DATE
H rt n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.- PLG.
F w z Professions C e,Said yyttyy license is in full for J ec ❑ ❑
Z, O H - License Class S2_Lic.Numb• _Ss ��1 gs
9 F D DmeM, ab- Contractor
x s t Q-`•5N-O y�`7•_" BU DING PERMIT
rcw OWNER.BUILUER DECLARATION - INFORMATION
w3. ,U.y I hereby affirm that I am exempt from file Contractor's License MISC.- REFER TO ORD VALUATION $/FT.
u o u, Law for the following reason.(Sec.7031.5,Ihon essand Professions PERMIT ISSUANCE 10.00
f w0i Code:Anycity orcounty which requires b permit to Construct,alter,
Q O improve,demolish,or repair any structure,poor to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
,iL E e u' requires life applicant for such pernit to file a signed statement that TOTAL a PERMIT TO
w.9 he is licensed pursuant to the provisions of the Contractor's License
FZi Law(Chapter 9(commencingwlOs Section7000)o(Division 3ofthS ,
Q Business and Professions Code)or that he isexempt therefrom and OTY. PLUMBING PERMIT FEE
IS 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; _ by zany applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(SS00).):
Cl I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the slmcluru is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,Provided that such improve-
ment,are not intended oro(fered for ale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA.) 200
builder will have the burden of proving that he did not build or an- . - . .
BUILDING USE
prove for purpose of sole). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB oma,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Low does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts far such projects with a com acmr(s)licensed pursuant to SEWER-SAN V-STORM EA.2001tI10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under See..,B,&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a ce'dried
copy thereof(Sec.3900.Lab.C.). "
Pol_tcy No. Company
O Certified copy is hereby Furbished. FIRESPRINK ENERGY T 24
Z 2 Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
C) Pplicont Y ❑ N❑ Y ❑ IN
~ rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.c,
LU CIiRTII%CAl'li OF EXEMPT IO TION PR(1M WORKERS'
W � COMPf;NSATION INSURANCE - PLG.CONTR. LIC.N0. PLG.
1 O (This section need not be-emandetcd if the permit is for ane TOTAL Y❑ N❑ Y❑ N❑
=) Z hundred dollars(S 100)or less.)
L) O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LLF mit is issued, 1 Shall not employ any Person in any mannorso as to
O become subject m the Workers'Compensation Laws of California.
0. Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ of NOTICE TO APPLICANT: If,after making Hits Certificate of li x.
1... ? Caption,you should became subject m the Warkeri Compensminn APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cade, you most forthwith comply with FEE
U such provisions Or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MDCF.K) 6',00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.1 8.00
Lender's Name
Lend,,',Address ELECTRIC
HEATING UNIT(OVER 100,000 B.T.U.)9.50 a _
-
I certify thai I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree to comply with all city and.Coun(y PLUMBING
ordinances and state laws relating to building construction, and BOILER•COMPI3 H.P.or 100,0008.T.U.1 6.00 �a-
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL `aL,
above-mentioned property for inspection purposes.
✓/ (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue,against aid City in consequence of the - _
/�r�an\ti��n�g/{�o\/f�th\is�permit, MECH.CONT. LIC.N0. MECH.
..v t�-� \n- � TOTAL ay' TOTAL yb �
Sngnalure of A`� lica ,/Con tractor Date
OFFICE COPY